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Palliative Care Practice in Neurocritical Care
Andrea K Knies1, David Y Hwang2
1Division of Primary Care, Yale School of Nursing, West Haven, Connecticut.
Seminars in Neurology
|December 2, 2016
Summary
Neurocritically ill patients require significant palliative care. All clinicians need core palliative care skills, emphasizing shared decision-making with surrogates for optimal end-of-life care discussions.
Area of Science:
- Neuroscience
- Palliative Care
- Critical Care Medicine
Background:
- Neurocritically ill patients and their families have substantial palliative care needs.
- Professional societies advocate for palliative care in neuroscience intensive care units.
- Optimal models for palliative care delivery remain under discussion.
Purpose of the Study:
- To review palliative care delivery models in neurocritical care.
- To emphasize shared decision-making in goals-of-care discussions.
- To discuss transitions to comfort care.
Main Methods:
- Literature review and synthesis of current practices and debates.
- Focus on communication strategies for shared decision-making with surrogates.
- Analysis of the role of decision aids in goals-of-care discussions.
Main Results:
- Consensus statements highlight the need for palliative care in neurocritical care settings.
- Core palliative care competencies are essential for all neurocritical care clinicians.
- Effective communication with surrogates is crucial, particularly regarding life support limitations.
Conclusions:
- Regardless of the delivery model, basic palliative care integration is vital.
- Enhanced communication skills are necessary for facilitating shared decision-making with surrogates.
- Decision aids can support best practices in goals-of-care discussions for neurocritically ill patients.
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